A partisan drug fight swirled in the background last year amid other developments in the nation’s opioid crisis. It's an unfortunate development whose continuation in 2018 should be watched closely.
When the New York Times, National Public Radio and Pro-Publica run stories the same month questioning the effectiveness of a drug used in what is called “Medically Assisted Treatment” of addition, one should be at least a bit wary that there is a campaign running in the background. Sure enough, NPR tipped its hand by quoting an anonymous Democratic Hill staffer in a piece last June, who feigned alarm about the lobbying tactics of one of the pharmaceutical companies involved in opioid treatment.
Pitting companies against each other, the media outlets question the motives of Vivitrol maker Alkermes PLC. The other company, Indivior PLC, makes Suboxone, which is portrayed as the preferred medication. Vivitrol and Suboxone work against addiction in fundamentally opposing ways. Vivitrol blocks opioid receptors in the brain, negating the euphoric feeling that causes addiction. Suboxone, itself an opioid, gives users a lower dose of the narcotic to wean addicts off more powerful “pain killer” drugs such as OxyContin and illegal heroin.
Fast forward to the end of last year and we see the agenda. California Democratic Sen. Kamala Harris called for an investigation of Alkermes, citing New York Times and NPR press reports. Her complaint boils down to the company’s lobbying tactics aimed at the criminal justice system, where Alkermes has a toe hold on the market. Vivitrol is the favored approach of many judges across the country, who believe blocking the effects of opioids keeps lawbreakers from returning to drug court. Corrections officials tend to prefer Vivitrol over Suboxone because the latter is smuggled into prisons so inmates can get high. There is no interest in diverting Vivitrol for illegal use because it produces no high and is not addictive.
Harris, however, falsely asserts that other drugs used in Medically-Assisted Treatment are proven to be more effective. And she’s not alone. A cadre of university professors challenge Alkermes. Joshua Sharfstein, an associate dean at the Johns Hopkins Bloomberg School of Public Health, told the New York Times that Alkermes puts its own “perverted idea” of marketing success ahead of solving the opioid epidemic.
In making such sweeping statements, Sen. Harris and professors like Sharfstein open the door to some much-needed fact-checking. A study conducted by the federal government’s National Institute on Drug Abuse finds Vivitrol and Suboxone treatments, once started, are equally effective in preventing relapse. Reported in November of last year, those findings went unmentioned in the senator’s press release issued that same month in which she calls for a congressional investigation. Yet she cites university professors, one of whom claims Alkermes “has taken unethical drug promotion to new depths” by enlisting judges, law enforcement personnel, and legislators to favor Vivitrol. Perhaps Alkermes has been more aggressive in lobbying than its competitor, but it’s unclear how that warrants a congressional investigation.
Annual sales of Suboxone are over $1 billion. The annual sales of Vivitrol are less than a quarter of that. Both companies are competing for market share where government programs such as Medicaid, state rehabilitation treatment grants and law enforcement spending are up for grabs. For better or worse, lobbying is going to play a large part in these companies’ success.
Vivitrol and Suboxone each have their pros and cons. Vivitrol requires a patient to undergo several days of painful detoxification before it is administered. Therefore, it’s much harder for many addicts to even start Vivitrol in the first place. The disclaimer for Suboxone states that it can be abused in a manner similar to other opioids, legal or illicit, according to the company’s website. But both medications also have a role in treatment of opioid addiction.
Pharmaceutical companies vying for public sector spending will compete for positive attention and attempt to shape public opinion. Most important is the larger issue of Medically Assisted Treatment. The key word is “assisted.” It’s widely accepted in the recovery community that no magic pill will replace the decision to quit drug use. But beware of agenda-driven politicians, professors, and reporters recommending one specific treatment drug.
Matt Mossburg, a former state legislator and recovering opioid addict, advises Maryland policymakers on treatment and recovery options.
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